Week 3 FOR INTRO – Ethical & Legal Considerations, Managing Client Care, Patient-Centered Care

Objectives

• Explore the Code of Ethics related to the nursing profession.
• Discuss values and their roles in ethical decision-making.
• Examine the relationship of ethical and legal practice to the nurse’s role.
• Identify actions related to breaches of nursing standards and potential consequences.
• Define and contrast advance directives, living wills, and power of attorney.

Legal Responsibilities & Scope of Practice

• Adherence to the Nurse Practice Act (state-specific)
  • Establishes scope; practicing outside = legal + ethical breach.
• Key legal duties
  • Duty of care, confidentiality, informed consent, accurate documentation, safe medication practice, mandatory reporting, advocacy, professional licensure, safe delegation.
• Client safety & injury prevention are ethical obligations per the Code of Ethics.
• Breaches lead to legal (loss of license), ethical (rights violations), and professional (discipline, reputation) consequences.

Nursing Codes of Ethics

• Applies to RNs, PNs, students, all settings, including social media.
• American Nurses Association (ANA) Code – 9 Provisions
  • 1–3: Compassionate, respectful care; advocacy; protection of health/safety.
  • 4–6: Authority, accountability, competence; duty to self; safe environment.
  • 7–9: Advance profession via research, policy, collaboration; promote justice.
• International Council of Nurses (ICN) Code (2021)
  • 4 elements: Clients, Practice, Responsibilities, Global Health.
  • New foci: Equity, social justice, climate change, technology, UN SDGs.

Ethical Principles

• Autonomy – respect client choice even if nurse disagrees.
• Beneficence – act for good of client.
• Non-maleficence – do no harm.
• Veracity – truth telling.
• Fidelity – keep commitments.
• Justice – fairness & equal resource allocation.

Personal & Professional Values

• Personal: shaped by culture, family, education; integral to identity.
• Professional (ANA): patient-centered care, confidentiality, evidence-based practice, lifelong learning, collaboration.
• Core professional values
  • Altruism – selfless concern; examples: rushing to help at own risk.
  • Autonomy – respect client self-determination.
  • Human dignity – uphold worth; privacy, pronouns, culture.
  • Integrity – honesty, admit errors.
  • Social justice – advocate for equity locally & globally.

Ethical Dilemmas & Decision-Making

• Dilemmas = conflicts of principles/values, no clear answer.
• Common issues: stem-cell research, MAiD, late-term termination, resource allocation.
• Simplified process
  1. Identify dilemma.
  2. Define stakeholders.
  3. List all solutions (no judgment).
  4. Apply principles & policies.
  5. Decide & implement.
  6. Review outcome.

Key Federal Laws

• EMTALA
  • Medical screening eval (MSE) for all.
  • Stabilize or appropriate transfer.
• HIPAA (1996)
  • Privacy Rule: protects PHI in any form.
  • Breach → \text{termination}, \text{fines}, \text{license loss}, \le 10-year prison.

Social Media Principles (ANA)

1. No identifiable client info.
2. Maintain professional boundaries.
3. Assume posts are visible.
4. Use privacy settings.
5. Report confidentiality violations.
6. Collaborate with employers for policy.

Genetic Testing

• GINA (2008) prevents insurance/employment discrimination.
• Ethical: confidentiality, autonomy; nurse ensures informed decision & referrals.

Criminal & Civil Law / Tort

• Criminal: beyond reasonable doubt; punishment.
• Civil: preponderance; compensation.
• Unintentional torts: negligence, malpractice.
• Intentional: invasion of privacy, defamation, assault, battery.
• Malpractice insurance: personal policy advised.

Consent Concepts

• Informed consent – provider explains procedure, risks, benefits, options; nurse verifies comprehension & witnesses signature.
• Minor consent – Title X allows reproductive services w/o parents at funded clinics; state laws vary.
• Implied consent – inferred from actions (arm out for BP) or emergencies.

Advance Directives

• Living Will – desired/undesired life-sustaining treatments.
• Durable Power of Attorney for Health Care – names proxy.
• Nurse: educate early, assess literacy, document, communicate teamwide.

Good Samaritan Laws

• Protect off-duty responders acting in good faith, without gross negligence, no pay.

Whistleblowing

• Report unsafe/illegal practices; laws protect from retaliation; require solid documentation & following channels.

Mandatory Reporting

• Abuse/neglect, violent injuries, specific communicable diseases (e.g., TB, HIV, measles, \text{COVID-19} where applicable).

Incident Reporting & Just Culture

• Report near-miss, actual, sentinel events immediately; objective language; do NOT chart “incident report”.
• Just culture: blameless learning, accountability, system improvement.

Standards of Care & Breach

• ANA Scope & Standards, Code, Social Policy Statement guide practice.
• Failure → adverse outcomes, litigation, Board action.
• Accurate assessment critical; omissions yield wrong diagnoses.

Nurse Fatigue & Substance Use Disorder (SUD)

• Fatigue → ↑ errors, health issues; AAN suggests ≤8-hr nights, breaks q2 hr, naps, caffeine.
• SUD signs: med discrepancies, frequent bathroom breaks; many boards offer treatment programs with monitoring.

Managing Client Care

Time & Organization

• Prioritize; avoid procrastination; use Time-Management Matrix (urgent vs important).
• SMART goals for self-improvement.

Delegation (Five Rights)

1. Task – within role, simple, predictable.
2. Circumstance – stable client & environment.
3. Person – competent delegatee.
4. Directions/Communication – clear, specific.
5. Supervision/Evaluation – nurse accountable.

Staffing & Assignments

• High ratios → ↑ mortality, errors, burnout.
• Only California mandates minimum ratios; ANA advocates expansion.
• Assignment types: direct, area, group; factors: census, proximity, acuity, nurse skill.

Discharge Planning – IDEAL

• Include, Discuss, Educate, Assess, Listen; use teach-back; ensure med comprehension, resources, warning signs.

Continuity & Collaboration

• Handoffs risk gaps; use SBAR, read-back.
• IPEC core competencies: values/ethics, roles, communication, teamwork.

Patient-Centered Care & Caring Theories

Watson’s Theory of Human Caring

• Transpersonal caring moments; 10 Caritas processes (loving-kindness, faith-hope, etc.).
• Nurses need self-care for presence.

Swanson’s Theory

• Maintaining belief, Knowing, Being With, Doing For, Enabling.

Caring Behaviors

• Listening, touch (with consent), presence, comfort interventions, compassion, honoring preferences.

Cultural Competence & Age Considerations

• 5 elements: awareness, knowledge, skill, encounters, desire.
• Cultural assessment Qs: identity, beliefs, diet, spirituality.
• Generational traits: Silent Gen (formal), Boomers (face-to-face), Gen X (direct + tech), Gen Y (feedback, tech), Gen Z (digital native).

Spiritual Care

• Spiritual assessment (FICA, HOPE).
• Spiritual distress signs: despair, doubt, restlessness.
• Interventions: active listening, prayer, chaplain referral, reflective space.

Telehealth & Technology

• Telemedicine: remote diagnostics/treatment via ICT; bridges rural gaps; cost-effective, safe.
• Telehealth encompasses clinical + non-clinical (education, monitoring).

Advocacy

• Protect rights, inform decisions, speak for vulnerable.
• Advocacy plan: assess, verify goals, implement, evaluate.
• Medical futility vs palliative care; nurse helps families weigh quality vs quantity of life.

Pastoral Care

• Chaplains support clients, families, staff; facilitate rituals; aid decisions; bolster well-being.

Numerical / Statistical References

• 1\text{ in }4 nurses assaulted at work.
• 59\text{ million} people (\ge 12 yr) used illicit drugs in 2020.
• Incident table example: 123 sentinel events; wrong-patient n=2 (1\%), suicides n=20 (16\%), etc.

Key Equations & Expressions (examples)

• Privacy breach fines: up to \$1{,}000{,}000+.
• Fatigue recommendation: rest break every 2 hr → \frac{8\text{ hr shift}}{2\text{ hr}} = 4 breaks.

Practical Implications & Takeaways

• Align personal values with professional standards.
• Use ethical principles + laws to guide every action.
• Maintain accurate, honest documentation.
• Employ just culture to learn from errors.
• Delegate wisely; retain accountability.
• Prioritize patient-centered, culturally competent, spiritually sensitive care.
• Advocate relentlessly for client rights, safety, quality, and dignity.